For physicians these are challenging times, with studies suggestingand

physicians reportingthat they are under tremendous stress to see more

patients in less time, and with less support, than in the past.
Written for physicians by physicians, the AMA has provided these
practical steps for resilience to remind physicians of two important
points: (1) that mental health is the cornerstone to a healthy and
productive life, and (2) recognizing periods of difculty with mental
health issues and seeking help can truly make a diference personally
and professionally.
If you identify a particular emotional health challenge in yourself or a
colleague, let this informationand useful, confdential resources
help you take steps toward assistance and resilience.
Take a moment to explore the following issues:
Anxiety
Physicians have anxiety disorders with the same frequency as
non-physicians, characterized by uneasiness and worry without relief
Burnout
Experienced by ~50 percent of physicians at some point in their career;
characterized by fatigue, depersonalization and mental exhaustion
Depression
Tree times more prevalent in physicians than with age-matched
cohorts
Suicide
On average, the rate of physician suicide has increased over the past
20 years, with studies suggesting that almost 365 physicians commit
suicide per year.
AMA Healthier Life Steps

A Physicians Guide to Personal Health

Practical steps for resilience
Please visit: ama-assn.org/go/physicianhealth
for more information or to subscribe to the
AMA Physician Health e-Letter.
2011 American Medical Association.
All rights reserved.
Anxiety
If you or a colleague are experiencing anxiety on a regular basis, here are
options to explore:
Treatment with psychotherapy, primarily cognitive behavior therapy
(CBT), is the cornerstone of treatment for anxiety disorders such as
generalized anxiety disorder, social phobia and post-traumatic stress
disorder, with or without medication.
Medications for anxiety disorders ofen are used in conjunction with
psychotherapy in order to achieve the best results. Tey include:
Antidepressant selective serotonin reuptake inhibitors (SSRIs) or
serotonin-norepinephrine reuptake inhibitors (SNRIs)
Benzodiazepines may be used short term for anxiety or as needed for
panic attacks, but these present a risk of tolerance and dependence
Youll nd additional resources at:
National Alliance on Mental Illness (NAMI)
National Institute of Mental Health (NIMH)
International OCD Foundation (IOCDF)
National Center for PTSD
Burnout
Burnout can happen to anyone in any specialty.
To distinguish between burnout and depression, consider that burnout
symptoms are almost always relieved afer adequate rest, vacation time,
and positive changes made in the work environment and/or work and life
balance. Tese changes do not alleviate symptoms of depression. In fact,
depressed physicians ofen take time of with the hope their symptoms
will remitbut the symptoms remain, or even worsen, on the vacation.
A hallmark of burnout is feeling detached and distant from ones work
and patients.
AMA Healthier Life Steps

Practical steps for resilience 2 American Medical Association

Treatment
It is best to prevent burnout, however, to combat it, taking time of and
changing work priorities can help.
Consider the following:
Get at least eight hours of sleep per night
Practice good nutrition
Regular mobility and/or mindfullness or yoga
Cultivate close relationships
Take regular breaks and/or vacations
To evaluate if you suffer from burnout, take a condential survey
at renewnow.org/RenewNow.html
Depression
Depression can be mistaken for burnout; however, one diference is the
length of symptoms. Burnout symptoms can be relieved by time away
from work, whereas depression symptoms persist beyond a vacation or
break from work. Te good news is that depression, even recurrent
depression, is usually very responsive to treatment.
Treatment
Tere are many efective treatments for depression, including various
psychotherapies.
Mild to moderate depression: cognitive behavioral therapy (CBT) or
supportive psychotherapy
Moderate to severe depression: there is a wide range of efective
antidepressant medications with diferent modes of action and side
efect profles (see page 2anxiety/antidepressants)
For severe and life-threatening depressions, electroconvulsive therapy
(ECT) may be indicated. Transcranial magnetic stimulation (TMS) is
another efective therapy for treatment-resistant depression
AMA Healthier Life Steps

Practical steps for resilience 3 American Medical Association

To evaluate if you are clinically depressed and to assess your level of
depression, take this confdential PHQ9 questionnaire. It is brief and
specifc for depression.
Youll fnd additional resources at:
Depression and Bipolar Support Alliance (DBSA)
Physician suicide
As stated earlier, the rate of physician suicide is increasing.
Why?
Mental illness
Substance abuse
Loss of a close relationship or death of a partner, adverse event in
practice
Treatment
Physicians who are referred, or self-refer, for suicidal thoughts, should
be seen by a psychiatrist immediatelythe same day, if possible
Most importantly, the suicidal physician must receive the same
standard of care as any other suicidal patient. Physician patients tend to
understate and minimize their symptoms and suicidal intent, and their
treating physicians are ofen infuenced by their own reluctance to
insist on an inpatient hospitalization, more intensive treatment, or a
mandatory leave from practice for their patient
If you or someone you know is suicidal, call the National Suicide
Prevention Lifeline: (800) 273-TALK (8255).
Additional references:
American Foundation for Suicide Prevention: afsp.org; click on Struggling in Silence.
Accessed December 19, 2011.

Depression and Bipolar Support Alliance, dbsalliance.org, click on Coping with a crisis.
Accessed December 19, 2011.
AMA Healthier Life Steps

Practical steps for resilience 4 American Medical Association

SEI:11-0639:PDF:06/12:df